Early results from the community pharmacy independent prescribing (IP) pathfinder programme show that the community pharmacy is increasing patient access to advice and medicines for acute and long-term conditions, according to an audit presented by Paula Wilson (Strategic Pharmacy Leader, NHS Midlands and Lancashire Commissioning Support Unit).

From 2026 onwards, all newly-registered pharmacists will be qualified as Independent Prescribers. In preparation for this development the Independent Prescribing in Community Pharmacy Pathfinder programme was set up, in selected sites, and went live in September 2024.  The purpose of the programme was to explore how community pharmacists and their teams could deliver integrated clinical services aligning prescribing activity with general practices and the population needs of local communities. The results from the pathfinder sites will be used to inform a commissioning framework for IP.

The data from 171 pathfinder sites were analysed for the period August 2024 to July 2025. A total of 30,351 consultations was recorded with 55% resulting in a prescribing decision – starting (42.3%), changing (10.2%), or stopping (2.9%) a prescription.  In total, 98.6% cases were closed by the pharmacist.  A number of different of clinical models or services were involved. By far the most common was for minor ailments (68%) followed by prescription management (8.4%), hypertension (7.5%) and lipid management (5.6%). The majority (79.7%) of consultations were completed face-to-face. Telephone consultations accounted for 17.8%. The average time taken for completion of a consultation was 22 minutes.

The authors concluded that the IP programme offered patients convenient appointments of longer duration than typical GP appointments and comparable to those offered by PCN pharmacists. As a result of the service, many patients did not need appointments with GPs. It is anticipated that a national roll-out will increase prescribing capacity in primary care, potentially increasing patient services, access and choice in the future.

Wilson P, Baqir W, Sidhu J, Titterton J, Dance J, Hampshaw S, Haydar G, Crouch T, Pearson H, Dulay M, Hobbs C Joshua A, Horgan J. Wearly findings from the Community Pharmacy Independent Prescribing Pathfinder Programme in England. Clinical Pharmacy Congress North, November 2025

Photo: Paula Wilson

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Researchers looked at population data from ICES to examine abortion service availability changes in Ontario from January 2017 to December 2022. Between 2017 and 2022, there were more than 226 000 abortions provided to 175 091 people. The proportion of regions with a pharmacy that dispensed mifepristone increased from 20% in 2017 to 82% in 2022. Only 37% of abortion service users lived in a region with either a mifepristone-dispensing pharmacy or procedural provider in 2017, but this increased to 91% by 2022.

Access to abortion services increased in both urban and rural areas.

“Despite these rapid gains in access to procedural or medication abortion services, in 2022, 6% of regions had no pharmacy at all, nearly 20% of regions with a pharmacy still lacked a pharmacy that dispensed mifepristone, and roughly 9% of abortion service users lived in a region without a local procedural provider or a pharmacy that dispensed mifepristone,” writes Dr. Laura Schummers, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, with coauthors.

The authors note that the expansion of mifepristone to community pharmacies shifted the delivery of abortions from procedural abortions to more accessible mifepristone abortions, a trend they expect to continue.

“Abortion service needs are time-sensitive, as risks of abortion complications increase exponentially with increasing gestational age. It is likely that the proportion of abortions provided by medication in Ontario will continue to increase beyond our study period, mirroring trends elsewhere.”

“Changes in local access to mifepristone dispensed by community pharmacies for medication abortion in Ontario: a population-based repeated cross-sectional cohort study” is published April 7, 2025.

Media contact: Media relations, ICES, media@ices.on.ca

General media contact: Kim Barnhardt, CMAJ, kim.barnhardt@cmaj.ca

Please credit CMAJ, not the Canadian Medical Association (CMA). CMAJ is an independent medical journal; views expressed do not necessarily reflect those of its owner, CMA Impact Inc., a CMA company, or CMA.

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This is part of a record £3.073 billion funding package for community pharmacies in 2025/26 announced by the Department of Health and Social Care (DHSC).  An additional £215 million has been allocated to sustain Pharmacy First and other Primary Care Recovery Plan services.

The provision of free emergency contraception through community pharmacies in England will bring them into line with services in Scotland and Wales. At present women seeking EHC in England face a so-called postcode lottery. In some areas EHC is available free of charge from pharmacies but in others it is only available for payment. GPs are able to issue EHC free of charge but there can be problems with access.

Pharmacists and registered pharmacy professionals who provide the service will have to complete the CPPE training package on emergency contraception.

Emergency contraception

There are two different types of emergency hormonal contraceptive pills:

• levonorgestrel 1.5mg – effective if taken within 3 days (72 hours) of sex
• ulipristal acetate 30mg – effective if taken within 5 days (120 hours) of sex

In addition, a non-hormonal, copper intra-uterine device (IUD) can be used for emergency contraception if inserted within 5 days of unprotected sex.

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With approximately 2.7 million individuals in the U.S. affected by OUD, the need for effective management strategies has never been more urgent. The PhARM-OUD Guideline marks a significant advancement as the first consensus, evidence-based practice guideline specifically tailored for community pharmacists, equipping them with essential tools to enhance patient care.

“Not all pharmacies stock medication for opioid use disorder, this new practice guideline will change that,” said Tyler Varisco, assistant professor of pharmaceutical health outcomes and policy at UH and principal investigator of the project. “By addressing the unique administrative and regulatory challenges they face, we aim to empower pharmacists to confidently dispense buprenorphine and provide effective care for those living with OUD.”

The PhARM-OUD Guideline provides nine major recommendations and 35 additional strategies designed to eliminate confusion and fear surrounding the dispensing of buprenorphine, a lifesaving medication for the treatment of OUD. It specifies key actions such as reducing stigma associated with dispensing buprenorphine, improving pharmacists’ understanding of state and federal regulation, and enhancing communication with healthcare providers. These guidelines are crucial because they not only address the knowledge gaps that have historically hindered pharmacists from providing OUD treatment but also foster an environment where pharmacists can confidently engage in patient-centered care. By equipping pharmacists with the tools and resources they need, the PhARM-OUD Guideline aims to increase the availability of buprenorphine and ultimately improve health outcomes for individuals receiving treatment for opioid use disorder.

Currently, only about half of U.S. pharmacies dispense buprenorphine, despite it being the only medication routinely provided by community pharmacists for OUD treatment.

Developed through a collaborative effort with an expert panel that includes psychiatrists, psychiatric pharmacists, and representatives from the National Association of Boards of Pharmacy and the National Community Pharmacists Association, the guideline reflects a comprehensive approach to pharmacy practice for patients with OUD. The American Society of Addiction Medicine, the American Pharmacists Association, the American Society of Health Systems Pharmacists, the American Association of Psychiatric Pharmacists, and Vital Strategies, a leading global public health organization, have all indicated their support for the guidance.

The PhARM-OUD Guideline is available on the National Association of Boards of Pharmacy website. Varisco, along with Douglas Thornton and Matthew Wanat in the Prescription Drug Misuse Education and Research (PREMIER) Center at the University of Houston College of Pharmacy will work closely with the National Community Pharmacists Association to develop educational materials that facilitate the adoption of these critical recommendations in more than 61,000 community pharmacies across the country.

The project was funded by a two-year, $572,278 grant from the Foundation for Opioid Response Efforts and is part of a broader $2 million initiative by FORE, which has awarded $33.9 million to combat the opioid crisis since its founding in 2018.

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What is the Pharmacy First Scheme and how can pharmacies get started?

The Pharmacy First Service embraces several aspects including the emergency supply of medications after referral from NHS 111 and dealing with minor illness referrals from GPs. Probably the area that has attracted most attention is the management of seven common infections in accordance with clinical protocols and Patient Group Directions (PGDs). The PGDs now allow community pharmacists to supply antibiotics to certain patients so that uncomplicated minor infections can be treated promptly without the need to visit a GP. They represent a stepping stone towards a broader community pharmacy service, says Ms Barai.

Marketing of the new service to GPs and patients was a key element of the preparations for the Pharmacy First Service.

Practicalities – what worked well in Pharmacy First?

Ms Barai was in contact with her local GPs from an early stage.  “The fact that we’ve got good, open dialogue and good relationships with our general practice colleagues is really helping to implement the service”, she says. Her team has also made use of AccuRx software to create templates for the safety-netting information and leaflets that have to be given to patients treated under one of the seven clinical pathways. AccuRx has also been used (with patient’s permission) to look at health records when detailed medical information was required to satisfy exclusion criteria in PGDs.

Some 41 patients were referred in the first month and 10 of those met the clinical pathway gateway, says Ms Barai. For seven of these, treatment was supplied using the PGD and the remaining three were provided with support for self-care.

Pharmacy First – where is it going next?

Reflecting on what has worked well and what is needed to carry the developments forward Ms Barai advises community pharmacists to think differently about how services are organised.  For example, in her pharmacy she is training an accredited checking dispenser and has set up an appointments system – measures that will allow better organisation of time and personnel for Pharmacy First consultations.

Another important step is preparation for the arrival of the 2026 cohort of pharmacy graduates, all of whom will be independent prescribers.  These people will look for places where they can use their prescribing skills in satisfying jobs and well-developed Pharmacy First Services will contribute to an attractive working environment, she predicts.

About Reena Barai

Reena Barai started her career as a hospital pharmacist 25 years ago and then took over her family (community pharmacy) business 20 years ago. She works in the pharmacy six days a week, running the pharmacy. In addition, she is a co-founder and co-host of the Female Pharmacy Leaders Network and until recently she was the co-chair of an Integrated Neighbourhood Team. Previously  she has worked in primary care and as a GP practice pharmacist and has been a CPP tutor. She has also served as a  board member of the National Pharmacy Association and as a Committee Member of what was the Pharmaceutical Services Negotiating Committee (PSNC),  now Community Pharmacy England (CPE).

Read and watch the full series on our website or on YouTube.

The post Pharmacy First – Early experiences appeared first on Pharmacy Update Online.

Beyond the pathways

“GPs can refer patients to us under the minor illness umbrella, which includes a lot more conditions than just those seven pathways[of Pharmacy First]. So, we are seeing more things actually in pharmacy than we’ve seen before, but to be honest since the Covid pandemic that’s been happening too because people just learn to use pharmacy in a different way”, says Ms Barai.

The PGDs and the training that Ms Barai and her team have undertaken have been helpful in developing further skills to help distinguish between common, simple conditions and complex or uncommon problems. “I think what we’re developing is our own kind of pharmacy ‘radar’ and our own kind of way of understanding – you know – which patients can I help, which patients can’t I help and actually which patients could I maybe help for a few days and then see if it works but actually give them support to know how to get back into the NHS if they need to if things don’t work out”, she explains.

During a consultation one patient had said to her, “Reena you’ve been my best-kept secret for a long, long time. Whenever I’ve got health problem I can just come and talk to you”. She added that she hoped the service did not get so busy that an appointment was needed. Ms Barai says “for patients who are ‘in the know’ pharmacies are the best kept secret because we really can help people – sometimes when they don’t know what to do or we can help signpost [them] to where they may need to go. And so I think ….. there is a really important role there for pharmacy in that primary care navigation”.

GP reaction

“On the whole, the majority of my GPs have been really, really supportive. Many have said come and come and spend some time in our clinics. We’ll help you look in people’s ears to get you more comfortable with doing things like that. They want to work with us so that we make sure that they send the right patients to us and then work with us in case we need to escalate a patient back”, explains Ms Barai. There will always be practices that do not wish to participate and some that struggle to adopt the referral mechanism, she acknowledges. However, “on the whole it’s been a really positive experience”, she says.

Tips for success

The introduction of Pharmacy First Services represents a considerable change and this comes on top of a day job that is already challenging. “My message to colleagues is – think differently about the team,  think differently about your day,  think differently about the services you offer and how many of those support the actual agenda of the business. So, I’m thinking about my team – in particular I have a dispenser who I’m training up to become an accredited checking dispenser which will allow us to have a bit more free time to be able to offer these consultations. I’m thinking about my pharmacy and my day and how can we make …. Pharmacy First consultations fit into our day. So, we’ve decided to do appointment systems between 10 and 12 and then two and four”, says Ms Barai.  Pharmacists might also need to think about whether one consultation room is sufficient and whether to invest in expanding the premises, she adds.

Next steps

Pharmacy services in Scotland, Northern Ireland and Wales already deal with a wider range of conditions and Ms Barai believes that parallel developments should now take place in England.  She identifies three key considerations for ongoing development: first, there needs to be a fully integrated IT system that supports smooth working for community pharmacists and their general practice colleagues. Second, the community pharmacy sector needs time for the changes to bed in. “We need to make sure that everybody’s on board and everyone’s doing a good job and providing a good service before we …. bolt on more”, she says. Third, is preparation for the arrival of the 2026 cohort of pharmacy graduates, all of whom will be independent prescribers.  Ms Barai explains, “My biggest concern is that they’re going to come out and work in community pharmacy and they may not be able to use their skills – and if they’re not using their skills in community pharmacy …. they’re going to go [and] work somewhere else where it’s sexier and possibly easier.”  The 2026 graduates will look for places where they can use their skills in satisfying jobs “and so actually it’s in our interest to do well with Pharmacy First. It’s in our interest to do well with all the services and to really show how we can safely supply using PGDs so that we can hopefully move that to independent prescribing and support a clinical decision-making model in Community Pharmacy……. I think that would be the future because of our future workforce. We can’t afford to lose those people. ….. and if we start to lose [them] because we’re not able to offer services that match the skills of our future workforce then we’re in trouble”.

About Reena Barai

Reena Barai started her career as a hospital pharmacist 25 years ago and then took over her family (community pharmacy) business 20 years ago. She works in the pharmacy six days a week, running the pharmacy. In addition, she is a co-founder and co-host of the Female Pharmacy Leaders Network and until recently she was the co-chair of an Integrated Neighbourhood Team. Previously  she has worked in primary care and as a GP practice pharmacist and has been a CPP tutor. She has also served as a  board member of the National Pharmacy Association and as a Committee Member of what was the Pharmaceutical Services Negotiating Committee (PSNC),  now Community Pharmacy England (CPE).

Read and watch the full series on our website or on YouTube.

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Briefing GPs

“This was probably the first time in my career where the GP practices were asking to talk to me. Normally I’m the one with my hand up saying, ‘Please can I come and talk to you about something?’ and this is the first time they’ve actually said, ‘Reena can you come and talk to us about Pharmacy First?’. So, that’s been really positive, really, really, encouraging”, says Ms Barai.  “I can see that general practice really want Pharmacy First to work”, she adds. If, as envisaged, the Pharmacy First Service frees up millions of GP appointments then GPs will be able to concentrate on the patients who really need their expertise. “The fact that we’ve got good, open dialogue and good relationships with our general practice colleagues is really helping to implement the service”, she says.

AccuRx

“When we were implementing this new service, we wanted to look for solutions that can make things a little bit easier for us and one of the IT softwares that we’ve been using for a long time is called AccuRx.  What we were using it for was a messaging system to our patients to tell them that their prescriptions ready or to invite them for a blood pressure check or remind them of a covid vaccine appointment and what we realised is that actually there’s more to AccuRx than we first thought”, she explains.  In fact, using AccuRx has enabled the pharmacy to do several things that underpin and enhance the services that are now being provided. For example, the team has been able to create templates for the safety-netting information and leaflets that have to be given to patients treated under one of the seven clinical pathways. This could be given during the consultation but sometimes it is helpful for patients to receive the information a few hours later when they have more time to digest it. In addition, “we’re able to use AccuRx, with the patient’s permission, to look at their health record  – and that’s really important when we’re taking important decisions to supply prescription-only medicines via Patient Group Directions”, she says. Some PGDs have long lists of exclusion criteria that require detailed medical information  and patients do not aways know the answers to these questions, so it is helpful to have access to the records in this way, she explains.

“The third thing that we’re really hoping to trial out is video consultations – that we’re able to do using AccuRx – and we feel this will be a game-changer because many pharmacies like mine only have one consultation room and actually, while we’re busy doing flu, Covid [vaccinations], hypertension, contraception and other local services plus Pharmacy First that one room is really being utilised quite a bit!”, says Ms Barai. If they were able to set up an area for video consultations that could be helpful for some patients. “We realise we can’t keep doing the things we’ve always done with the change that’s coming. We need to think differently and kind of bring [in] some digital tools to support us”, she says.

First experiences

“We saw 41 patients in the first month who were referred to us and 10 of those patients met the clinical pathway gateway”, says Ms Barai. For seven of these, treatment was supplied using the PGD but the remaining three were provided with support for self-care. This was important she says because she was able to explain that the illness was not so severe as to require antibiotic treatment but that the patient could return if symptoms worsened. Moreover, she points out, “the route to get back into pharmacy is really, really simple you just turn up or you ring. It’s not like you have to ring the next day at 8:30 in the morning try to get an appointment then they say ‘sorry we have to wait three days’ and so actually what Pharmacy First is going to create, I think, is an absolutely great way of supporting the self-care agenda.”

Ms Barai also believes that a reduction in overall prescribing of antibiotics might occur because of the Pharmacy First scheme. This could happen “because of the ease with which patients can come back if their symptoms deteriorate”. Currently this option rarely exists in general practice so patients may pressure prescribers for antibiotics or prescribers may err on the side of caution and prescribe antibiotics, for example, for young children.

About Reena Barai

Reena Barai started her career as a hospital pharmacist 25 years ago and then took over her family (community pharmacy) business 20 years ago. She works in the pharmacy six days a week, running the pharmacy. In addition, she is a co-founder and co-host of the Female Pharmacy Leaders Network and until recently she was the co-chair of an Integrated Neighbourhood Team. Previously  she has worked in primary care and as a GP practice pharmacist and has been a CPP tutor. She has also served as a  board member of the National Pharmacy Association and as a Committee Member of what was the Pharmaceutical Services Negotiating Committee (PSNC),  now Community Pharmacy England (CPE).

Read and watch the full series on our website or on YouTube.

The post Practicalities – what worked well in Pharmacy First? appeared first on Pharmacy Update Online.

The Pharmacy First Service embraces several aspects including the emergency supply of medications after referral from NHS 111 and dealing with minor illness referrals from GPs. Probably the area that has attracted most attention is the management of seven common infections in accordance with clinical protocols and Patient Group Directions (PGDs). The seven conditions are: acute otitis media, impetigo, infected insect bites, shingles, sinusitis, sore throat and uncomplicated urinary tract infection. Patients can be referred to the pharmacy by their GP or can self-refer and simply walk into the pharmacy.

For some years patients with minor illnesses have been encouraged to consult a pharmacist in the first instance but “there was a limit to what we could do and what we could supply to treat these patients”, says Ms Barai. It was frustrating for pharmacists to be unable to supply the required treatment and complete the episode of care, she explains. “What was actually happening was we were ….. sometimes able to offer some self-care advice, sometimes able to offer something they could buy over the counter to help relieve their symptoms but sometimes having to refer them back to the general practice to see somebody to get something prescribed”, she says.  The Pharmacy First Service was born partly in response to the problems with access to GP services post-Covid and, in particular, recognition of the need to  reduce the workload in primary care so that general practice only sees the patients that it really needs to see. Patients with simple, minor conditions or common conditions that are included in the Pharmacy First seven clinical pathways can then be seen by a community pharmacist – often closer to home and with no appointment necessary – so it’s more convenient for patients too, she explains.

Patient Group Directions (PGDs)

“The PGDs are legislation that allows the safe supply of a prescription-only medication (POM) by certain healthcare professionals and within all PGDs you’ve got inclusion criteria and exclusion criteria”, explains Ms Barai. Many community pharmacists also have independent prescribing qualifications, she notes. “I think PGDs are a great stepping stone towards what I’d love to see in community pharmacy – that …. there is an independent prescriber in every pharmacy” Such individuals should have a scope of practice that would allow them to support patients more effectively than in the past. Furthermore, integrated IT will be essential  “so that when we’re prescribing, everybody knows what we’re doing and [that] we’re doing things safely and that to me is the ultimate goal and I think that’s why Pharmacy First and the clinical pathways are really exciting. We’ve had PGDs before with vaccines and things like that but this is the first time [that] we’re really getting them at a national level for antibiotics and products like that. So, I really hope the sector embraces it. …. I’d love to see pharmacy technicians being able to use Patient Group Directions in the future as well”, she says.

Getting started

“The preparation for Pharmacy First has been quite intense”, recalls Ms Barai. Her team spent the whole of January looking at the protocols and clinical pathways, understanding the PGDs and working out how to operationalise the service. Training was high on the list “because we all felt that there were some skill gaps in our knowledge and we wanted to make sure that we were able to safely look inside somebody’s ear, for example, and feel confident of what we’re looking at”, she says. It was also important to ensure that the day-to-day running of the pharmacy was under control because “we didn’t know whether we’re going to have a queue out the door on the first day” or whether demand would be steady. “The third element was the marketing – talking to our GP colleagues, talking to our patients about this new service and making sure that they were aware of the ins and outs and …. how the service works and how people can be referred or how they can walk in to see us”, she explains.

About Reena Barai

Reena Barai started her career as a hospital pharmacist 25 years ago and then took over her family (community pharmacy) business 20 years ago. She works in the pharmacy six days a week, running the pharmacy. In addition, she is a co-founder and co-host of the Female Pharmacy Leaders Network and until recently she was the co-chair of an Integrated Neighbourhood Team. Previously  she has worked in primary care and as a GP practice pharmacist and has been a CPP tutor. She has also served as a  board member of the National Pharmacy Association and as a Committee Member of what was the Pharmaceutical Services Negotiating Committee (PSNC),  now Community Pharmacy England (CPE).

Read and watch the full series on our website or on YouTube.

The post What is the Pharmacy First Scheme and how can pharmacies get started? appeared first on Pharmacy Update Online.

Why should vitamin D levels be measured in community pharmacy?

Growing recognition of the role of vitamin D in numerous disease states, beyond bone health and increasing demand for vitamin D supplementation to boost immunity during the coronavirus pandemic were two factors that led the researchers to select vitamin D POCT as an area for study, says Dr Busuttil. In particular, the absence of readily accessible, inexpensive, non-invasive, quick and reliable methods of vitamin D assessment sparked her interest.

A total of seven POCT devices were appraised and the Acro Biotech Inc. Vitamin D rapid test, which gives a semi-quantitative result, was selected. The device was validated against the standard high performance liquid chromatography tandem mass spectrometry (HPLCMS) laboratory method.

What point-of-care testing for vitamin D levels tells us

The pilot study in a community pharmacy included 80 participants. Some 49 participants had ‘insufficient’ and eight had ‘deficient’ vitamin D levels.

“In Malta serum [25-hydroxyvitamin D (25D)] reference ranges follow those proposed by the Endocrine Society in the USA. Their guidelines state that 30 nanograms per millilitre are considered adequate levels, between 20 to 30 nanograms per millilitre are regarded as insufficient levels and below 20 nanograms per millilitre are deemed deficient”, explains Dr Busuttil.

The recommended daily dose of vitamin D supplementation (in Malta) is 800 to 2,000 International Units. Despite the fact that 38 participants were taking vitamin D supplementation, only 23 participants were found to have ‘sufficient’ levels of vitamin D and there was no statistical association between the two variables.  Possible reasons for this include underdosing of vitamin D supplementation, short duration of vitamin D supplementation and issues related to vitamin D malabsorption.

The next phase of this study will involve evaluation of the implementation of the Vitamin D POCT service within a community pharmacy, says Dr Busuttil.

About Catherine Anne Busuttil

Catherine Anne Busuttil holds a Master’s degree in Pharmacy and a Doctorate (PharmD) of Pharmacy.  As part of her doctoral studies at the University of Malta she undertook research in the area of vitamin D POCT under the supervision of Dr Francesca Wirth and Professor Lillian Azzopardi. She now contributes to the department as a teacher-practitioner for second year pharmacy students in POCT practical sessions and for postgraduate students on community pharmacy rotations.

Read and watch the full series on our website or on YouTube.

The post Establishing a community pharmacist-led vitamin D point-of-care testing service appeared first on Pharmacy Update Online.

Following the selection and validation of the vitamin D point of care test (POCT) a framework for the service, comprising a standard operating procedure together with appropriate documentation, was prepared. This was piloted in a community pharmacy with 80 participants.  Some 49 participants had ‘insufficient’ and eight had ‘deficient’ vitamin D levels.  Further analysis showed that “participants suffering from chronic conditions were more likely to have their vitamin D levels tested – and those suffering from metabolic disorders being even more likely to have deficient or insufficient vitamin D levels – and this correlation had a p value of 0.026 showing its significance”, explains Dr Busuttil.

The test procedure itself involves collecting approximately 20 microlitres of finger-stick whole blood. This is transferred to the test cassette and the result is obtained after 10 minutes by comparing the intensity of the line on the test cassette to the colour card provided with the POCT kit. “It is crucial that the test is carried out in a well-lit area for clear colour comparison”, notes Dr Busuttil.

“In Malta serum [25-hydroxyvitamin D (25D)] reference ranges follow those proposed by the Endocrine Society in the USA. Their guidelines state that 30 nanograms per millilitre are considered adequate levels, between 20 to 30 nanograms per millilitre are regarded as insufficient levels and below 20 nanograms per millilitre are deemed deficient”, she explains.

Despite the study being carried out in Malta which has a Mediterranean climate, 71 percent of participants had deficient or insufficient levels of vitamin D.  “Participants who are aware that exposure to UVB rays is essential to vitamin D photosynthesis are more likely to spend time in the sun”, says Dr Busuttil. However, prolonged sun exposure is not recommended as this can lead to sunburn and DNA damage, she adds.  There has also been an occupational shift over recent years where the majority of the general population works from offices or their homes and therefore sun exposure is restricted.  Despite the fact that 38 participants were taking vitamin D supplementation, only 23 participants were found to have sufficient levels of vitamin D and there was no association between the two variables when statistical analysis was carried out.  Dr Busuttil explains: “This may be attributed to underdosing of vitamin D supplementation, short duration of consumption of the required dose of vitamin D and issues related to vitamin D malabsorption. Finally, half of the participants tested stated that they suffered from a metabolic disorder.  Metabolic disorders considered included hypertension, hypercholesterolemia, hypothyroidism, obesity and type 2 diabetes. Statistical significance was observed when the occurrence of vitamin D hypovitaminosis and the presence of a metabolic disorder were correlated, giving a p value of 0.026, so there is quite a large significance there”.

In Malta the recommended daily dose of vitamin D supplementation is 800 to 2,000 International Units (for a healthy individual with no other conditions).

If vitamin D POCT were routinely available from a community pharmacy, the price would depend on the type of test kit used. The semi-quantitative test kit used in the study costs the community pharmacy €6 per test. A quantitative test costs approximately €14 to €27 – with an additional cost of €3,000 for an analyser. Total costs would need to take into account the costs of consumables, wastage and pharmacists’ time, Dr Busuttil points out.

The next phase of this study will involve evaluation of the implementation of the Vitamin D POCT service within a community pharmacy. “However, I would just like to highlight that it is our obligation as community pharmacists to educate and to offer these kind of testing services within our pharmacy to highlight our role to prevent and protect the patients within our community and to provide individualised pharmaceutical care”, says Dr Busuttil.

About Catherine Anne Busuttil

Catherine Anne Busuttil holds a Master’s degree in Pharmacy and a Doctorate (PharmD) of Pharmacy.  As part of her doctoral studies at the University of Malta she undertook research in the area of vitamin D POCT under the supervision of Dr Francesca Wirth and Professor Lillian Azzopardi. She now contributes to the department as a teacher-practitioner for second year pharmacy students in POCT practical sessions and for postgraduate students on community pharmacy rotations.

Read and watch the full series on our website or on YouTube.

The post What point-of-care testing for vitamin D levels tells us appeared first on Pharmacy Update Online.

The ability to offer a portfolio of POCT “enhances the role of the pharmacist beyond dispensing”, says Dr Busuttil. Furthermore, “patients benefit from early screening and non-invasive monitoring of diseases coupled with personalised advice and referral as needed”, she adds.

Dr Busuttil is the first author on a recent publication entitled, Establishing a community pharmacist-led vitamin D point of care testing service.  Growing recognition of the role of vitamin D in numerous disease states, beyond bone health and increasing demand for vitamin D supplementation to boost immunity during the coronavirus pandemic were two factors that led the researchers to select vitamin D POCT as an area for study, she says. In particular, the absence of readily accessible, inexpensive, non-invasive, quick and reliable methods of vitamin D assessment sparked her interest.

Vitamin D POCT devices

A total of seven POCT devices were appraised, assessing manufacturer, technology used, storage and stability, specimen type, testing time, results, testing range, quality control, service sensitivity and cost. Only three POCT devices were available locally (in Malta), all of which used immunochromatographic technology. One gave a semi-quantitative result which is read by the analyst while the other two require the use of a secondary device to give a quantitative result. The secondary device is a Cube Reader or a mobile phone application.

Dr Busuttil explains: “The device selected for use was the Acro Biotech Inc. Vitamin D rapid test cassette [which gives] a semi-quantitative result, at a cost of 6 Euro per test, not including additional consumables and pharmacy fees. The selected device is very easy to use and is minimally invasive to patient, giving the result within 10 minutes. The lack of need for operators to read the result makes the test most accessible and adapted to ambulatory care settings.”

The device was validated against the gold standard method, which is high performance liquid chromatography tandem mass spectrometry (HPLC-MS), in 20 participants. This was done in the laboratory of the main acute general hospital in Malta. Vitamin D POCT was carried out on the same day as intravenous blood was collected for laboratory measurement of vitamin D levels.  “The Cohen’s Kappa [coefficient] was used to assess concordance between the two methods, giving a value of 0.84, which signifies near perfect agreement between the two results”, says Dr Busuttil.

About Catherine Anne Busuttil

Catherine Anne Busuttil holds a Master’s degree in Pharmacy and a Doctorate (PharmD) of Pharmacy.  As part of her doctoral studies at the University of Malta she undertook research in the area of vitamin D POCT under the supervision of Dr Francesca Wirth and Professor Lillian Azzopardi. She now contributes to the department as a teacher-practitioner for second year pharmacy students in POCT practical sessions and for postgraduate students on community pharmacy rotations.

Read and watch the full series on our website or on YouTube.

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Why pharmacists should manage repeat prescriptions

The current system for repeat prescriptions for patients with stable conditions requires them to return to the GP every 6-12 months even if nothing has changed.  Allowing community pharmacists to manage repeat prescribing “would take a huge amount of workload off general practice and enable them to spend their time doing the things that they really are experts at doing”, he says. Community pharmacists, who are experts at managing medicines and medicines’ optimisation, could monitor patients effectively and manage medicines for those with stable conditions. Much of this could be done under agreed protocols and that could bridge the gap until all community pharmacists are prescribers, he argues.

Getting Serious Shortage Protocols (SSPs) to work

Medicines’ shortages are depressingly frequent and, despite the existence of Serious Shortage Protocols (SSPs) to ensure that alternative medicines are available when shortages occur, numerous problems have arisen. The SSP scheme is not as flexible and responsive as it needs to be and sometimes the way in which the schemes operate in practice simply leads to new shortages and delays in treatment. Pharmacists are clinicians who care about patients and need to be trusted to provide the appropriate alternatives when a specific product is unavailable, says Professor Soni. Patients do not want to be travelling back and forth between health care professionals trying to find a solution, “they want the solution in one easy place so let’s find ways that the patient has that access at the point they want it, in the way they want it”, he says.

Reducing harm from medicines and improving the patient experience

About eight per cent of hospital admission are due to medicines-related harm. This could be reduced by improving prescribing and pharmacy-led medicines optimisation initiatives. Such measure should release capacity for patient care. Ideally pharmacy services should be built in when new initiatives are planned. Although this did not happen for the covid vaccination campaign it quickly became apparent that without input from community pharmacy there would be insufficient capacity. Now, the majority of vaccine provision for covid is now delivered through community pharmacy, explains Professor Soni.

Integrating community pharmacy and primary care

The National Association of Primary Care (NAPC) is an organisation that is focused on the delivery of care outside hospital. As such it embraces all branches of health and social care, including the voluntary sector. It’s guiding principle is “about enabling people at local level to build things from the ground up”, says Professor Soni.

His closing message to the Secretary of State for Health and Social Care is, “All pharmacists have a role to play in supporting improving care. …… We want to be part of your solution – we can be part of your solution – but you have to include us for that to happen.”

Pharmacists have a role to play in supporting improving care. If you really want us to help, we can – just come and ask us, let us. We want to be part of your solution – we can be part of your solution – but you have to include us for that to happen.”

Read and watch the full series on our website or on YouTube.

The post How primary care pharmacy could help the NHS work more effectively appeared first on Pharmacy Update Online.